Suchergebnisse

BackgroundPost-sexual violence service utilization is often poor in humanitarian settings. Little is known about the service uptake barriers facing male survivors specifically.MethodsTo gain insights into this knowledge gap, we undertook a qualitative exploratory study to better understand the barriers to service utilization among male survivors in three refugee-hosting countries. The study sites and populations included refugees who had travelled the central Mediterranean migration route through Libya living in Rome and Sicily, Italy; Rohingya refugees in Cox's Bazar, Bangladesh; and refugees from eastern Democratic Republic of the Congo, Somalia, and South Sudan residing in urban areas of Kenya. Methods included document review, 55 semi-structured focus group discussions with 310 refugees, semi-structured key informant interviews with 148 aid workers and human rights experts, and observation of service delivery points. Data were thematically analyzed using NVivo 12.ResultsWe identified eleven key barriers and situated them within a social ecological framework to describe impediments at the policy, community (inter-organizational), organizational, interpersonal, and individual levels. Barriers entailed: 1) restrictions to accessing legal protection, 2) legislative barriers such as the criminalization of same- sex sexual relations, 3) few designated entry points, 4) poor or nonexistent referral systems, 5) lack of community awareness-raising and engagement, 6) limited staff capacity, 7) negative provider attitudes and practices, 8) social stigma, 9) limited knowledge (at the individual level), 10) self-stigma, and 11) low formal help-seeking behaviors.ConclusionThe social ecological framework allowed us to better understand the multifaceted ways that the barriers facing male survivors operate and reinforce one another, and may be useful to inform efforts promoting service uptake. Additional research is warranted in other refugee settings.

Aims: To elucidate i) the challenges and constraints in the development and implementation of the regulatory framework for nursing professionals in Cambodia, and ii) the specific strategies adopted to address the challenges experienced in Cambodia.Introduction: The health workforce will be critical to achieving the health-related and wider Sustainable Development Goals in the years up to 2030. Background: In 2006, the countries of the Association of Southeast Asia Nations signed a Mutual Recognition Arrangement in relation to nursing services in the region with the main aim of facilitating the mobility of nursing professionals between countries. To ensure the competency of the health workforce and the quality and safety of health services, member states are required to establish an appropriate regulatory framework. Methods: This is a descriptive qualitative study. Eighteen key informant interviews were conducted in Cambodia in 2018. Walt & Gilson's policy analysis model was applied to organise and synthesise the data. Findings: Major challenges were identified such as conceptual and cultural issues, limited capacity of Cambodian stakeholders, and an unstandardized system with limited coordination. Discussion: In Cambodia, the nursing regulatory environment has expanded greatly over the last decade. Strategies adopted were "political leadership", optimal utilization of "outsider's capacity", strengthening "insider's capacity", and "dedicated consultation and collaboration and consensus building" involving all players. Implications for nursing and health policies: Policy makers in similar resource-limited countries could apply and adapt similar strategic efforts when formulating and implementing health policies, legislation and regulations. "Outsiders", in this case, represented by development partners can play a vital role in the process, but should not be leading the charge. They should be aligned with national priority to support recipient countries. It is imperative for these countries and development partners to invest in increasing the quantity and quality of nursing leaders who can develop and advance regulatory functions.

The Republic of South Sudan continues to face considerable challenges in meeting maternal, newborn and child health (MNCH) care needs and improving health outcomes. Ongoing instability and population displacement undermine scope for development, and damaged infrastructure, low coverage of health services, and limited government capacity and human resource base have resulted in a fragmented health system. Despite considerable attention, effort and support, the issues and challenges facing South Sudan remain deep and sustained, and urban-rural disparities are considerable. There is a need to maintain investments in MNCH care and to support developing systems, institutions and programs. This paper review of the published literature provides an overview and summary of the current MNCH situation in South Sudan. It explores the barriers and challenges of promoting MNCH gains, and identifies priorities that will contribute to addressing the Millennium Development Goals and the emerging health priorities for the post-2015 development agenda.

BACKGROUND: Malaria is a major global health problem, often exacerbated by political instability, conflict, and forced migration. OBJECTIVES: To examine the impact of political upheaval and population displacement in Timor-Leste (2006) on malaria in the country. METHOD: Case study approach drawing on both qualitative and quantitative methods including document reviews, in-depth interviews, focus group discussions, site visits and analysis of routinely collected data. FINDINGS: The conflict had its most profound impact on Dili, the capital city, in which tens of thousands of people were displaced from their homes. The conflict interrupted routine malaria service programs and training, but did not lead to an increase in malaria incidence. Interventions covering treatment, insecticide treated nets (ITN) distribution, vector control, surveillance and health promotion were promptly organized for internally displaced people (IDPs) and routine health services were maintained. Vector control interventions were focused on IDP camps in the city rather than on the whole community. The crisis contributed to policy change with the introduction of Rapid Diagnostic Tests and artemether-lumefantrine for treatment. CONCLUSIONS: Although the political crisis affected malaria programs there were no outbreaks of malaria. Emergency responses were quickly organized and beneficial long term changes in treatment and diagnosis were facilitated.

Background: Tuberculosis (TB) is a major public health problem in developing countries. Following the disruption to health services in East Timor due to violent political conflict in 1999, the National Tuberculosis Control Program was established, with a local non-government organisation as the lead agency. Within a few months, the TB program was operational in all districts. Methods and Findings: Using the East Timor TB program as a case study, we have examined the enabling factors for the implementation of this type of communicable disease control program in a post-conflict setting. Stakeholder analysis was undertaken, and semi-structured interviews were conducted in 2003 with 24 key local and international stakeholders. Coordination, cooperation, and collaboration were identified as major contributors to the success of the TB program. The existing local structure and experience of the local non-government organisation, the commitment among local personnel and international advisors to establishing an effective program, and the willingness of international advisers and local counterparts to be flexible in their approach were also important factors. This success was achieved despite major impediments, including mass population displacement, lack of infrastructure, and the competing interests of organisations working in the health sector. Conclusions: Five years after the conflict, the TB program continues to operate in all districts with high notification rates, although the lack of a feeling of ownership by government health workers remains a challenge. Lessons learned in East Timor may be applicable to other post-conflict settings where TB is highly prevalent, and may have relevance to other disease control programs. © 2006 Martins et al.

ABSTRACT: The COVID-19 pandemic has disrupted every sphere of life and livelihoods around the world. Many migrant workers from the Global South, such as Bangladesh, working in the Gulf countries were reported to be impacted by COVID-19, but the direct voices and views of migrant workers themselves and their households are largely unknown. This research adopts a mixed-method approach to assess the impact of the pandemic on foreign remittances to Bangladesh and the well-being of migrant households. The primary data collection involved fieldwork conducted in four migrant-dense villages, situated in Mymensingh and Meherpur districts of Bangladesh. A set of 221 household surveys was administered. In addition to the surveys, 52 semi-structured interviews were carried out, engaging with key individuals at community, district, and national levels such as heads of migrant households, returnee migrants, managers of migration financiers, owners of labor recruiting agencies, officials of the district manpower office etc. Results show that although a significant number of Bangladeshi migrant workers returned home since the COVID-19 pandemic and the outflow of Bangladeshi migrant workers shrank by 69 percent in 2020, remittance inflows at the national level witnessed a growth of 18.5 percent in 2020, which did not resonate with the negative prediction made by the World Bank. However, this research found a macro-micro mismatch, indicating a substantial decline in remittances at the household level. This might be due to the existence of a robust unofficial channel for remittance sending. Approximately 62% of migrant households in the case study sites experienced a 32% reduction in remittances during the COVID-19 pandemic compared to the pre-COVID-19 period. In response to the decline in remittance income, a majority of migrant households (77%) resorted to utilizing their accumulated savings. Additionally, approximately 20% of households sought financial support and borrowing from friends, relatives, and community members. At the community level, the local economy experienced a sharp downturn, leading to a ripple effect that affected everyone within the community. To address the unofficial remittance sending, the Government of Bangladesh should implement effective measures to curb unofficial remittance channels. Upskilling initiatives have the potential to alleviate the vulnerability of Bangladeshi migrant workers, fostering increased income stability. Policymakers should place greater emphasis on crafting savings instruments tailored to the specific needs of migrant households. It is also imperative to prioritize an income diversification policy at the community level to mitigate dependence on remittances.

Over the last four decades, Bangladesh has made considerable improvements in population health, this is in part due to the use of evidence to inform policymaking. This systematic review aims to better understand critical factors that have facilitated the diffusion of scientific evidence into multiple phases of health policymaking in Bangladesh. To do this an existing policy framework designed by Shiffman and Smith in 2007, was used to extract and synthesize data from selected policy analyses. This framework was used to ensure the content, context and actors involved with evidence-informed policymaking were considered in each case where research had helped shape a health policy. The 'PRISMA Checklist' was employed to design pre-specified eligibility criteria for the selection of information sources, search strategy, inclusion and exclusion criteria, and process of data extraction and synthesis. Through our systematic search conducted from February to May 2017, we initially identified 1859 articles; after removal of duplicates, followed by the screening of titles, abstracts and full-Texts, 24 articles were included in the analysis. Health policy issues included the following topics: maternal and child health, tobacco control, reproductive health, infectious disease control and the impact and sustainability of knowledge translation platforms. Findings suggested that research evidence that could be used to meet key targets associated with the Millennium Development Goals (MDGs) were more likely to be considered as a political (and therefore policy) priority. Furthermore, avenues of engagement between research organizations and the government as well as collective action from civil-society organizations were important for the diffusion of evidence into policies. Through this article, it is apparent that the interface between evidence and policy formulation occurs when evidence is, disseminated by a cohesive policy-network with strong leadership and framed to deliver solutions for problems on both the domestic and global development agenda.

BackgroundCuba has extended its medical cooperation to Pacific Island Countries (PICs) by supplying doctors to boost service delivery and offering scholarships for Pacific Islanders to study medicine in Cuba. Given the small populations of PICs, the Cuban engagement could prove particularly significant for health systems development in the region. This paper reviews the magnitude and form of Cuban medical cooperation in the Pacific and analyses its implications for health policy, human resource capacity and overall development assistance for health in the region.MethodsWe reviewed both published and grey literature on health workforce in the Pacific including health workforce plans and human resource policy documents. Further information was gathered through discussions with key stakeholders involved in health workforce development in the region.ResultsCuba formalised its relationship with PICs in September 2008 following the first Cuba-Pacific Islands ministerial meeting. Some 33 Cuban health personnel work in Pacific Island Countries and 177 Pacific island students are studying medicine in Cuba in 2010 with the most extensive engagement in Kiribati, the Solomon Islands, Tuvalu and Vanuatu. The cost of the Cuban medical cooperation to PICs comes in the form of countries providing benefits and paying allowances to in-country Cuban health workers and return airfares for their students in Cuba. This has been seen by some PICs as a cheaper alternative to training doctors in other countries.ConclusionsThe Cuban engagement with PICs, while smaller than engagement with other countries, presents several opportunities and challenges for health system strengthening in the region. In particular, it allows PICs to increase their health workforce numbers at relatively low cost and extends delivery of health services to remote areas. A key challenge is that with the potential increase in the number of medical doctors, once the local students return from Cuba, some PICs may face substantial rises in salary expenditure which could significantly strain already stretched government budgets. Finally, the Cuban engagement in the Pacific has implications for the wider geo-political and health sector support environment as the relatively few major bilateral donors, notably Australia (through AusAID) and New Zealand (through NZAID), and multilaterals such as the World Bank will need to accommodate an additional player with whom existing links are limited.